LAY HEALTH ADVISERS - A STRATEGY FOR GETTING THE WORD OUT ABOUT BREAST-CANCER

Transforming natural helpers into lay health advisors (LHAs) is a comp lex undertaking. Using the North Carolina Breast Cancer Screening Prog ram(NC-BCSP) as a case study this article describes the steps involved in developing, implementing, and evaluating an LHA intervention, cons idering factors that make the LHA approach appropriate for the NC-BCSP 's population, setting, and health focus. The authors review five phas es of implementation (start-up, training, LHA activities, follow-up, r esource mobilization) and discuss the NC-BCSP's evaluation strategies and tools in light of difficulties involved in assessing natural helpi ng processes and impact. Program challenges related to resource needs, identification of natural helpers, and LHA monitoring and support als o are considered. The authors describe ways in which one large group o f older, rural, African American LHAs are helping establish countywide partnerships between health care providers, agencies, and local commu nities that support and sustain individual changes in health behavior.